Efficacy and Safety of High-Frequency Repetitive Transcranial Magnetic Stimulation for Poststroke Depression: A Systematic Review and Meta-analysis

Liu, Chaomeng; Wang, Meizi; Xia, Liang; Xue, Jinyan; Zhang, Guiqing

doi:10.1016/j.apmr.2019.03.012

Cited by 22 publications

(17 citation statements)

References 21 publications

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“…In detail, the results included the following: seven studies for motor function, 62–68 three for manual dexterity, 69–71 three for walking and balance, 72–74 three for spasticity, 64,75,76 six for dysphagia, 77–82 five for aphasia, 83–87 three for unilateral neglect, 88–90 three for post-stroke depression and vascular depression, 66,91,92 one for cognitive function, 66 and one for CPSP. 93 The study by Graef and colleagues 64 included data on both motor function and spasticity and, therefore, the results were independently considered for both categories.…”

Section: Resultsmentioning

confidence: 99%

“…92 Regarding the stimulation frequency, the efficacy of 10 Hz stimulation over the left DLPFC was supported by a recent meta-analysis including only HF-rTMS studies. 91…”

Section: Resultsmentioning

confidence: 99%

“…92 Regarding the stimulation frequency, the efficacy of 10 Hz stimulation over the left DLPFC was supported by a recent meta-analysis including only HF-rTMS studies. 91 In short, the evidence seems to support the efficacy of rTMS (particularly HF-rTMS) over the left DLPFC for post-stroke depression. The widely proved efficacy of rTMS for the treatment of major depression disorder encourages further trials.…”

Section: Post-stroke Depression and Vascular Depressionmentioning

confidence: 94%

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Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

Fisicaro

Lanza

Grasso

et al. 2019

Ther Adv Neurol Disord

145

101

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Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.

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Section: Resultsmentioning

confidence: 99%

“…92 Regarding the stimulation frequency, the efficacy of 10 Hz stimulation over the left DLPFC was supported by a recent meta-analysis including only HF-rTMS studies. 91…”

Section: Resultsmentioning

confidence: 99%

Section: Post-stroke Depression and Vascular Depressionmentioning

confidence: 94%

See 1 more Smart Citation

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

Fisicaro

Lanza

Grasso

et al. 2019

Ther Adv Neurol Disord

145

101

View full text Add to dashboard Cite

show abstract

“…The results showed that the combination of NIBS and antidepressants might have a better effect on PSD and could improve the depression scale score and quality of life compared with antidepressants alone. It is well known that guidelines recommend rTMS for the treatment of major depression, and many meta-analyses have shown that TMS intervention with PSD was positive ( Shen et al, 2017 ; Liu et al, 2019 ; Shao et al, 2021 ), but a growing number of studies have recommended multi-module combination therapy and population-specific personalized treatment ( Wang et al, 2019 ; Nestor and Blumberger, 2020 ), which warrants further research on the frequency and site of TMS intervention. The use of low-frequency TMS by Daniel R Schaffer significantly improved depression with cognitive impairment, suggesting that low-frequency TMS is more effective in specific populations ( Schaffer et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…The use of low-frequency TMS by Daniel R Schaffer significantly improved depression with cognitive impairment, suggesting that low-frequency TMS is more effective in specific populations ( Schaffer et al, 2021 ). Compared with previous reviews ( Bucur and Papagno, 2018 ; Liu et al, 2019 ), our analysis had the following advantages (I) combination NIBS and antidepressant therapy; (II) internationally recognized depression assessment scales; (III) inconsistent results with previous studies due to negative outcomes of high-frequency TMS combined with antidepressants; and (IV) the inclusion of more than 30 studies. There have been no studies evaluating NIBS in combination with antidepressants for PSD, although combination therapy is more clinically appropriate.…”

Section: Discussionmentioning

confidence: 99%

Effects of Noninvasive Brain Stimulation Combined With Antidepressants in Patients With Poststroke Depression: A Systematic Review and Meta-Analysis

Liang

Jiang

et al. 2022

Front. Pharmacol.

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Objective: To evaluated the efficacy and safety of noninvasive brain stimulation (NIBS) combined with antidepressants in patients with poststroke depression (PSD).Methods: Seven databases were searched to identify randomized controlled trials of NIBS combined with antidepressants in the treatment of PSD based on the international classification of diseases (ICD-10) criteria and exclusion criteria. The retrieval time was from the database establishment to 31 October 2021. Two researchers independently screened the identified studies through the search strategy, extracted their characteristics, and evaluated the quality of the included literature. Cochrane Collaboration’s tool was used to assess risk of bias. RevMan 5.3 software was applied for meta-analysis.Results: A total of 34 randomized controlled trials were included, involving 2,711 patients with PSD. Meta-analysis showed that the total effective rate was higher in the combined therapy than the antidepressant alone [odds ratio (OR): 4.33; 95% confidence interval (CI): 3.07 to 6.11; p < 0.00001]. The Hamilton depressive scale (HAMD) score was significantly lower in repeated transcranial magnetic stimulation (rTMS) (≤10 Hz) combined with antidepressant than in antidepressant alone [standard mean difference (SMD): −1.44; 95% CI: −1.86 to −1.03; p < 0.00001]. No significant difference was seen in rTMS (>10 Hz) combined with antidepressant versus antidepressant alone (SMD: −4.02; 95% CI: −10.43 to 2.39; p = 0.22). In addition, combination therapy more strongly improved the modified Barthel index (MBI) scale than antidepressants [mean difference (MD): 8.29; 95% CI: 5.23–11.35; p < 0.00001]. Adverse effects were not significantly different between two therapies (OR: 1.33; 95% CI: 0.87 to 2.04; p = 0.18).Conclusion: Low-frequency rTMS (≤10 Hz) combined with antidepressants tends to be more effective than antidepressants alone in patients with PSD, and there are no significant adverse effects. In addition, combined therapy may enhance quality of life after stroke. Combination therapy with high-frequency rTMS (>10 Hz) showed no advantage in treating PSD. The transcranial electrical stimulation (TES) combined with antidepressants might be more effective than antidepressants alone, which are needed to confirm by more clinical trials since the.

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Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke

Allida

Hsieh

Cox

et al. 2023

Cochrane Database of Systematic Reviews

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Efficacy and Safety of High-Frequency Repetitive Transcranial Magnetic Stimulation for Poststroke Depression: A Systematic Review and Meta-analysis

Cited by 22 publications

References 21 publications

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

Effects of Noninvasive Brain Stimulation Combined With Antidepressants in Patients With Poststroke Depression: A Systematic Review and Meta-Analysis

Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke

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